Serological Testing In Patients Research Articles

The use of hepatitis B vaccine in U.S. dental schools

A questionnaire was sent to the deans of 59 dental schools in the United States. They were asked to indicate their plans for the use of the new hepatitis B vaccine, whether hepatitis B antigen-positive patients were treated in the dental school clinics, and if so, what special precautions were used. The requirements for serological testing of patients were also addressed. Fifty questionnaires were returned. Eight schools (16 percent of the respondents) had not formulated plans for use of the vaccine. Thirty-one schools (62 percent) planned to use it for all students, faculty, dental assistants, and hygienists. In 74 percent of the schools planning to use the vaccine, the cost would be borne by the recipients; in 16 percent, costs would be paid by the institution. Several stated that the cost would be shared by both. Twenty percent of the respondents had not yet formulated plans for payment. The responses indicated that a great deal of indecision still exists among dental administrators as to the use of the hepatitis B vaccine and who will assume the cost.

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Dermatitis herpetiformis (DH) is a cutaneous manifestation of celiac disease (CD), the latter being identified by circulating autoantibodies against native gliadin (nGli), tissue transglutaminase (tTG), endomysium, or a combination of these. Recently, a novel serologic assay using deamidated gliadin-analogous fusion peptides (GAF3X) showed high diagnostic sensitivity in patients with CD.The aim of this study was to explore the anti-GAF3X enzyme-linked immunosorbent assay (ELISA) and to compare it with a panel of classic CD-related serologic tests in patients with DH.Antibodies against nGli, GAF3X, and tTG were determined by separate ELISA tests and against endomysium by indirect immunofluorescence microscopy in 45 patients with DH and 52 control patients (30 patients with bullous pemphigoid and 22 patients with linear IgA disease). A total of 24 patients with DH underwent intestinal biopsies to confirm underlying CD.Antibodies to nGli were detected in 26 (58%) (IgA) and 24 (53%) (IgG), to GAF3X in 38 (84%) (IgA) and 36 (80%) (IgG), to tTG in 35 (78%) (IgA), and to endomysium in 32 (71%) (IgA) patients with DH. Combined testing of IgA and IgG antibodies to GAF3X detected 7 of 10 (70%) IgA-anti-tTG-negative patients with DH and together with the IgA-anti-tTG ELISA showed the highest serologic hit rate (93%) for CD.Intestinal biopsies were not performed in all patients with DH.The novel anti-GAF3X ELISA shows a higher sensitivity to detect CD-associated autoantibodies in patients with DH compared with tests using nGli, tTG, or endomysium as substrates.

Evaluation of intradermal and serologic tests for the diagnosis of hydatid disease.

SummaryIntradermal tests utilizing an aqueous extract of Echinococcus multilocularis cyst material were performed on 104 individuals living in Uruguay for evaluation of the skin test. In this group, 43 individuals had proven hydatid disease and 61 were normal or had non-hydatid diseases. Antigens containing 0.012 to 0.401 mg N/ml were used. Highest specificity was obtained with skin test antigens which contained 0.012 to 0.015 mg N/ml.Sera from 124 individuals were collected in Uruguay. All but four of the skin-test group were included. Each serum was tested by the indirect hemagglutination, bentonite flocculation and latex agglutination tests. None of the sera in the non-hydatid group reacted in the hemagglutination test and only a few reacted in the bentonite and latex tests. The sensitivity of the serologic tests in patients infected with E. granulosus varied from 82% for serum from individuals with liver cysts to 33–50% for serum from patients with lung cysts.

Pericarditis due to histoplasmosis

Two additional cases of pericarditis due to histoplasmosis, including the second known case of constrictive pericarditis, have been reported. This makes a total in the available literature of 3 proved cases, and 6 cases which are presumptive because of positive histoplasmin skin and/or serologic tests in patients with anergy to tuberculin.

Spondylitis following Weil's disease.

<h3></h3> <b>Background:</b> Unnecessary laboratory tests contribute to the financial burden placed on hospitals, patients, insurers, and taxpayers. In our institution, we noted acute viral hepatitis serologic testing in patients with chronic liver disease, sometimes done repetitively, in the absence of substantially elevated aminotransferase levels. The goal of this study was to determine the frequency of unnecessary testing for acute hepatitis A and B infections and then reduce testing rates by implementing an intervention in the electronic health record. <b>Methods:</b> In a 2-year period, 2 successive interventions questioning the appropriateness of ordering viral hepatitis serology based on transaminase elevation and prior serology results were implemented in the electronic health record system at Saint Louis University Hospital. The first intervention allowed providers to override the warning without providing a reason; the second intervention required justification to proceed with the order. Preintervention and postintervention appropriate and inappropriate testing proportions were compared using Fisher exact test. <b>Results:</b> The electronic reminders resulted in a statistically significant reduction of inappropriate testing rates; however, testing rates remained high whether the provider had to justify overriding the automatic alert or not. <b>Conclusion:</b> Our research demonstrated that the rates of inappropriate testing for acute viral hepatitis at our institution were unnecessarily high and showed that a simple intervention in the medical record system may be useful in reducing inappropriate testing. Our interventions were feasible and implemented at minimal cost. Similar interventions could be used to target other unnecessary tests, but education and additional interventions will likely be required to reduce unnecessary testing further.